User:Voicedisordersmegan/sandbox

I hope to contribute some information about the types of tasks that one could expect to participate in during an assessment of puberphonia. I would also like to clarify some of the information at the beginning of the article, to better describe that it is a functional voice disorder and to shed some light on what that means.

Some information that could go into the introduction:

Puberphonia (also known as "mutational falsetto" or "functional falsetto") is a type of functional voice disorder. This means that there are no physical problems causing the voice's high pitch. Instead, the disorder stems from problems with the individual's use of the voice mechanism. Patients present with tense muscles surrounding the vocal folds caused by habitual use of a high pitch when speaking.

Voice therapy performed by a speech-language pathologist (S-LP), is usually effective in treating puberphonia. The S-LP will focus on modifying the patient's usual voice behaviour (i.e., helping to decrease the muscle tension in the larynx that raises the pitch of the voice). Both direct and indirect treatment options can help improve functional voice disorders like puberphonia.

Indirect treatment options for puberphonia focus on creating an environment where direct treatment options will be more effective. Counselling, performed by the S-LP or by a psychologist or counsellor, can help patients identify the psychological factors that contribute to their disorder and give them tools to address those factors directly. Patients may also be educated about good vocal hygiene and how their behaviour will affect their voice in the long term. This may increase their motivation to participate in treatment and gives strategies to protect the voice in their daily life.

Assessment

To determine whether a client presents with puberphonia, a complete voice assessment including medical and diagnostic evaluations is recommended. These assessments are performed by otolaryngologists and speech-language pathologists.

Patient Profile

Puberphonia is most often diagnosed in adolescent or adult male clients. These patients often seek referral to a voice professional because of the social consequences of speaking in the falsetto register. Because a high-pitched voice is not pathologized in women, women are less likely to be referred to clinicians to treat falsetto speech. Some older adult women, however, may seek a referral for this disorder due to increasing weakness of their voice and vocal fatigue at the end of the day (these cases are often referred to as "juvenile voice" rather than puberphonia).

Medical Evaluation

Puberphonia is a functional voice disorder. To rule out problems in the structure of the larynx as the cause of their voice issues, clients are often referred to otorhinolaryngologists for a physical examination of the larynx and vocal folds. Once physical pathologies are ruled out, a behavioural evaluation can occur.

Behavioural Evaluation

A behavioural assessment for puberphonia will consist of several types of tasks, and may include:

• Examining for tension in the neck and throat: The clinician will visually examine the area around the larynx to see if the voice box sits high in the throat, and palpate the area to determine whether there is excessive muscular tension.

• Determining the relationship between tension and vocal pitch: The clinician will ask the client to perform warm-up and relaxation exercises such as those listed in the Treatment section below to determine whether the client has access to their modal voice register.

• Establishing vocal range: The clinician will ask the client to produce the lowest and highest pitch that they can, and perform different speaking or singing activities at various pitches.

• Listening for abnormal traits: The clinician will listen for the presence of breathy voice, an indication of speech in the falsetto register, and other distortions of vocal quality.

• Taking aerodynamic measurements: Many individuals with puberphonia may have limited breath support caused by the thoracic or shallow breathing patterns often used to support speech in the falsetto register. These symptoms are assessed using vocal tasks such as maximum phonation time and direct measures of breath support such as glottal airflow and subglottal pressure.

Other Evaluations

Clinicians will also ask for a self-assessment, in which the client describes their symptoms and their effects on activities of daily living. The clinician may direct this self-assessment to include the identification of personality traits that may maintain the disorder, the social and emotional consequences of the symptoms experienced, and whether the client has any access to their modal voice register.

A complete assessment for puberphonia or any other voice disorder may require a referral to another healthcare professional, such as a psychologist or a surgeon, to determine candidacy for different treatment options.